Blue nevus of the nail: A case report and review.

Blue nevus (BN), in all its clinical variants, rarely affects the nail bed. This leads to difficulty in the diagnosis of BN within the nail bed as well as to challenges with regard to its treatment and follow-up management, not solely attributed to the intrinsic difficulty of the anatomical site. We present the first case in the literature of an acquired cellular BN entirely confined within the nail bed, in a female Caucasian patient. We propose diagnostic and therapeutic options based on personal clinical and surgical experience.

The Effectiveness of Local Surgical Technique in Treatment of Axillary Bromhidrosis.

BACKGROUND: Up to now, surgical excision of apocrine glands still has been a method that yields high treatment results and low rate of odour recurrent for patients, but many people worry about some serious complications that have been observed postoperatively, such as hematoma and skin necrosis. These prolong wound healing, leading to unsightly scars in the axillary fossae. AIM: We conducted this research to investigate the effects and complications of our surgical technique for axillary bromhidrosis. METHODS: Forty-three patients with axillary bromhidrosis were treated. An elliptical incision was made at a central portion of the area marked, with both tips of the ellipse along the axillary crease. The elliptical skin with the subcutaneous tissue was removed en lock. The adjacent skin was undermined to the periphery of the hair-bearing area with straight scissors. The undermined subcutaneous tissue was removed with curved scissors, and the skin was defatted to become a full-thickness skin flap. Any suspected hemorrhagic spots were immediately coagulated electrosurgically. Appropriate drains were placed, and the treated area was covered with thick gauze to each axilla. Arm movement was strictly controlled in the first 3 days post-operatively. RESULTS: Thirty-one patients have been followed up and evaluated for 6 months. 56 out of 62 axillae (90.3%) showed good to excellent results for malodor elimination. All patients reported a reduction in axillary sweating. There were two axillae of skin necrosis and three axillae of hematoma, with one patient receiving an anticoagulant from a cardiologist after the first day of surgery, to treat heart valve disease. The Dermatology Life Quality Index (DLQI) score decreased significantly, and the quality of life improved after the operation. CONCLUSION: Our technique is a simple surgical procedure and easy to perform helping to achieve results for high malodor elimination, with almost no serious complications. Patient's life quality improved significantly after the operation.

Anatomical Evaluation for Successful Dye Laser Treatment of Port Wine Stain in Vietnamese Patients.

AIM: To assess the efficacy in the treatment of port wine stain in the head and neck by using (Vbeam perfecta®). METHODS: Forty-two port wine stain patients were recruited at the National Hospital of Dermatology and Venereology, Hanoi, Vietnam. RESULTS: We reported an excellent response (43.8%) (76%-100% lightening), a good response (18.8%) (51%-75% lightening), fair improvement (18.8%) (26%-50% lightening), and no response (18.8%) (0%-25% lightening). CONCLUSION: In conclusion, pulsed dye laser is an excellent technique to remove port wine stains on the face and neck.

Efficacy of Surgical Excision for Nevus Sebaceous - Vietnamese Experience.

BACKGROUND: Nevus Sebaceous (NS) is hamartoma predominantly composed of sebaceous glands and is classified as a type of epidermal nevus. In most case, clinical manifestation of NS is typical, so histopathology examination is important only in atypical lesions for its risk of malignancy. Clinical symptoms are plaques or papules (100%), appearing in the head area (100%) with smooth surface (65.8%), usually with hair loss (60.7%). The histopathology is mostly characterized by the image of sebaceous gland hyperplasia (100%), no hair follicles (60.7%) or immature follicles (14.3%). AIM: The aim of our study is describing clinical and histopathological manifestation, make diagnosis and evaluate the best therapy. METHODS: Our study recruited 38 patients with NS, 3 patients (7.9%) with atypical aspects. All patients were treated by surgical excision. RESULTS: Complications as hair loss and infections were reported in 36.8% patients. No patients had recurrence after one year of treatment. CONCLUSION: Based upon our experience, surgery is cheap, simple, associated with high aesthetics effectiveness and low recurrence rate, proposing as the first choice for treatment of NS.

Serial Excision for the Treatment of Giant Congenital Melanocytic Nevus: The Vietnamese Way.

AIM: To investigate the efficacy of plastic surgery in the treatment of giant congenital melanocytic nevus (GCMN). METHODS: We enrolled 20 patients with 44 lesions and performed one of the following procedures: serial excision, skin grafting, tissue expansion, primary skin closure, distant flap, and adjacent flap. We assessed the outcome at 10 days and 6 months after surgery. RESULTS: Of 44 surgical sites, the most commonly used reconstruction surgeries were serial excision (16), skin grafting (16), and tissue expansion (6). Other types were rarely used. All patients with serial excision had good outcome. A total of 81% and 19% of the patients with skin grafting had good and fair outcome, respectively. Around 83% and 17% of the patients with tissue expansion had good and fair outcome. No cases had bad outcome. CONCLUSION: In conclusion plastic surgery is effective in the treatment of GCMN. There are different techniques but serial excision, skin grafts, and tissue expansion are most commonly used.

Effectiveness, Safety and Tolerance of Methotrexate in Vietnamese Psoriatic Arthritis Patients.

AIM: To access the effectiveness, safety and tolerance of methotrexate (MTX) in psoriatic arthritis (PsA) treatment. METHODS: We recruit 37 patients, admitted at HCMC Hospital of Dermato-Venereology from 1/2016 to 3/2017, with MTX dosage ranging from 10 mg to 15 mg per week. RESULTS: Skin lesion response after 12 weeks improved PASI 50: 40.5%, PASI 75: 24.3%. Disease activity score decreased after 12 weeks with ∆DAS28 = -1.43 + 0.79, 37.8% PsA achieved complete remission. Nausea and vomiting were 8.1%. These symptoms were mild and transient. We did not stop MTX usage. The rate of elevating SGPT 2-3 times as much as the upper limit of the normal range was 2.7%. CONCLUSION: We finally demonstrated that the rate of treatment response in Vietnam is the same as demonstrated by foreign authors in other countries.

Successful Treatment of Vitiligo Vietnamese Patients with Vitilinex® Herbal Bio-Actives in Combination with Phototherapy.

BACKGROUND: Vitiligo is an acquired pigmentary disease, that causes progressive loss of melanocytes, resulting in hypopigmented skin patches. Current treatments aim at stopping the disease progression and achieving repigmentation of the amelanotic areas. Corticosteroids, surgery, topical immunomodulators, total depigmentation of normal pigmented skin and phototherapy are current treatment options for vitiligo although phototherapy remains the treatment of choice. There is no documented evidence that herbal bio-active products may also be effective treatment options for vitiligo. AIM: This study aimed to investigate the efficacy and safety of Vitilinex® (herbal bio- actives) alone and in combination with UVB narrowband (311 nm) phototherapy, in the treatment of localised stable or active forms of vitiligo. MATERIAL AND METHODS: Sixty two subjects with mean age 34.5 years (range: 18-58 years) with mild to moderate vitiligo, consisting of 36 females and 26 males were randomly divided into three treatment groups - Group A (13 females, 10 males) treated with Vitilinex® alone; Group B (12 females, 11 males) were treated with Vitilinex® in combination with narrowband UVB (311 nm) phototherapy for 15 seconds, using a handheld lamp and Group C (8 females, 8 males) were treated with nbUVB (311 nm) phototherapy alone, for 15 seconds over a 12-week period. RESULTS: In Group A, 9 patients (39%) achieved outstanding improvement with a re-pigmentation rate higher than 75%, with 2 patients experiencing total repigmentation. 6 patients (26%) had marked improvement with a repigmentation rate between 50-75% while 5 patients (22%) showed a moderate response between 25-50% re-pigmentation rate. 3 patients (13%) had minimal or no improvement. In Group B, 16 patients (69.5%) achieved outstanding improvement with a re-pigmentation rate higher than 75%, with 12 patients experiencing total re-pigmentation. 4 patients (17.5 %) achieved a marked improvement with a re-pigmentation rate between 50-75%; 2 patients (8.7%) showed a moderate response with a re-pigmentation rate between 25-50%. 1 (4.3%) patient had minimal or no improvement. In Group C, 6 patients (37.5%) achieved a re-pigmentation rate higher than 75%, with 2 patients experiencing total re-pigmentation. 4 patients (25%) achieved marked improvement with a re-pigmentation rate between 50-75% while 3 patients (18.75%) had a re-pigmentation rate between 25-50%. 3 patients (18.75%) had minimal or no improvement. CONCLUSION: Vitilinex® herbal bio-actives in combination with nbUVB is a more effective treatment option for vitiligo with 87% of the patients achieving a re-pigmentation rate higher than 50%, compared to Vitilinex® alone (65%) or nbUVB alone (62.5%).

Microneedling Therapy for Atrophic Acne Scar: Effectiveness and Safety in Vietnamese Patients.

AIM: To evaluate the effectiveness and safety of micro-needling therapy in atrophic acne scar treatment. METHOD: A prospective, single centred study was implemented in a total of 31 patients suffering from atrophic acne scar grade 2 to 4 of Goodman and Baron scaring grading system was recruited. They were treated by microneedle derma roller every week in 3 months. The scars were evaluated by a magic system camera and by dermatologists clinically using Goodman and Baron scaring grading system, and Lipper and Perez score at baseline, at final treatment, 1 month and 2 months after the final treatment. RESULTS: The results showed improvement in all patients. The mean of Goodman and Barron's grade was decreased from 3.29 ± 0.59 at baseline, 2.23 ± 0.56 at final treatment, 1.93 ± 0.58 one month after the completion of therapy and to 1.77 ± 0.57 two months after the completion of therapy (with the p-value < 0.05). Similarly, Lipper and Perez score also dropped significantly from 36.48 ± 12.07 at baseline to 23.16 ± 15.01 at final treatment, to 17.83 ± 7.00 one month after the final treatment and to 16.37 ± 7.29 at two months after the final treatment (p-value < 0.05). Skin roughness and hyperpigmented spots got improved significantly. History of having nodular-cystic or vulgaris acne did not affect the effectiveness of the therapy. Side effects of the therapy were burning sensation, erythema but they were very mild and recovered in 1-2 days. No severe complication and post-inflammatory hyperpigmentation were noted. 83.3% of the patients satisfied after the completion of the therapy. CONCLUSION: Skin needling is an effective and safe method for the treatment of atrophic acne scars.

The Relationship between HLA-B27, HLA-Cw06, HLA-DR7 and Psoriatic Arthritis in Vietnamese Patients: Disease Progression and Therapeutic Burden.

We conducted a prospective, cross-sectional study at Ho Chi Minh City Hospital of Dermato Venereology from January 2016 to March 2017 in 40 psoriatic arthritis (PsA) patients to evaluate the disease progression and therapeutic burden about the HLA patterns. Based upon our results, PsA with HLA-B27 (+) had a threat of severe arthritis. PsA with HLA-Cw06 (+) had a higher risk of earlier onset and shorter duration for plaque psoriasis to transform into PsA. HLA-DR7 (+) in PsA delayed the time for conversion from plaque psoriasis into PsA. These findings are quite similar to other studies in the literature.

A "Yellow Submarine" in Dermoscopy.

BACKGROUND: Histiocytic sarcoma (HS) is an extremely rare, non-Langerhans cell tumor. HS affects especially adults, its etiology is unknown yet. Skin could be interested by papules or nodules, single or multiple. CASE REPORT: A Caucasian man in his late 40s came to our clinic for a naevi evaluation. During the visit, a rose papulonodular lesion was observed in the lumbar region. This lesion was completely asymptomatic, and it had been there for an indefinite period. The clinical evaluation revealed that the lesion appeared elevated, of 9 x 15 mm in dimension, symmetrical and of a homogeneous pinkish colour. The videodermoscopical evaluation revealed a homogeneous yellow central pattern, polymorphic vessels, an eccentric peripheral pigmentation and a white collar. An excisional biopsy was performed. The morphology and the expression of CD163, CD68 and/or lysozyme to the immunophenotypic analysis, revealed the true nature of the lesion. CONCLUSION: HS is usually diagnosed at an already advanced clinical stage and it has a high mortality rate even today. Dermoscopy, showing a yellow and distributed homogeneously colour, can facilitate its hard diagnosis.

Once in a Blue Moon Rare Adnexal Tumor: From the Clinical and Videodermoscopical Aspects to the Mohs Surgery and the Histological Diagnosis.

The adnexal tumours are a very heterogeneous group of lesions, more and more studied in the literature. The squamoid eccrine ductal carcinoma (SEDC) is a rare malignant variant that combines ductal structures with squamous differentiation. We report a case of dermoscopic and histological diagnosis of SEDC, treated with Mohs Surgery and with no recurrence of a tumour after 12 months of follow up.

Post-bariatric abdominoplasty: our experience.

The fast increase in obesity has been followed by the growth in the demand for plastic surgery in formerly obese patients. The weight loss is accompanied by new dysfunctions and disorders of the outline of the body that affects the quality of life of the patient. Abdominoplasty is a cosmetic surgery procedure that aims to remove the excess of skin and the redundant fat. The aim of this paper was to analyze our experience in this field and to test how functional abdominoplasty improved quality of life in the operated patients. In our Unit from January 2012 to December 2014, 25 patients (18 women and 7 men, age: 24 - 79 years, mean: 51 years) underwent abdominoplastic surgery. Only at least six months after bariatric surgery the patients were eligible for functional abdominoplasty. Average weight of the patients before surgery was 83.5 kg (range 58 - 163 Kg); averege BMI was 31 (range 24.77 - 57). The average quantity of tissue removed was 1.765 Kg (range 250 g - 11,5 Kg). Minor complications rate was in agreement with the percentages reported in literature. No mortality and major complications have occurred in our series. The majority of patients undergoing post-bariatric abdominoplasty reported an improvement in the quality of life and psychological well-being. In our opinion, however, only a multidisciplinary (surgical, psychological, dietological) approach of the post-bariatric patient allows to maintain long-term aesthetic and functional results.